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Biomedical subjects

M Luther

Publications and source records attributed to M Luther.

At least 37 records · Page 2Linked to original sources
PubMed1998

Factors affecting the results of surgery for chronic critical leg ischemia--a nationwide survey. Finnvasc Study Group.

PURPOSE: To assess the factors affecting immediate outcome of surgery for chronic critical leg ischemia, especially the influence of surgeon's caseload and hospital volume. METHODS: The data of Finnvasc registry were retrospectively analyzed. A total of 11,747 surgical vascular reconstructions included 1,761 operations for chronic critical leg ischemia during 1991 to 1994. RESULTS: The 30-day postoperative leg amputation rate was 7.5% and the mortality rate 4.7%. Diabetes, previous vascular surgery or amputation, preoperative ulcer or gangrene, a surgeon's annual caseload fewer than 10 operations, and hospital volume fewer than 20 operations for chronic critical leg ischemia adversely affected amputation rates. The presence of coronary artery disease and renal dysfunction increased postoperative mortality rates. Both amputation rates and postoperative mortality rates were affected by the type of procedure. CONCLUSIONS: A surgeon's caseload and hospital volume affect amputation rate, but not mortality rate, in patients operated for chronic critical leg ischemia.

Aged↗
PubMed1998

Infrainguinal reconstructions: influence of surgical experience on outcome.

OBJECTIVES: To evaluate the influence of surgical experience and operation technique on the outcome of infrainguinal reconstructions. DESIGN: A longitudinal observational study of patients undergoing reconstructions to the popliteal and crural arteries. SETTING: A regional hospital and an academic referral centre. MATERIALS: 392 patients undergoing 442 reconstructions, 218 to the popliteal and 228 to the crural vessels. CHIEF OUTCOME MEASURES: Graft patency and leg salvage. MAIN RESULTS: At the popliteal level, 5-year patency after autogenous vein reconstruction was 76%. No difference was found between in situ and transposed vein reconstructions, but prosthetic reconstructions had a worse patency. At the crural level, 5-year patency for in situ vein, transposed vein and prosthetic bypass were 66, 55 and 21%, respectively. Corresponding leg salvage for chronic critical leg ischaemia was 91% with vein and 55% with prosthetic reconstruction at popliteal level, and 66 and 33% at the crural level. Surgical experience improved the outcome, as 3-year patency for in situ and transposed vein bypasses to the popliteal level were 82 and 95% for experienced surgeons, and 53 and 75% for less experienced surgeons. Corresponding leg salvage rates for reconstructions to the popliteal and crural levels were 85 and 67% for experienced surgeons, and 61 and 52% for less experienced surgeons. CONCLUSIONS: Outcome of infrainguinal reconstructions is influenced by the reconstruction level. Surgical experience and choice of the appropriate reconstruction technique can improve outcome.

Aged↗
PubMed1998

The utility of duplex scanning in infrainguinal vein graft surveillance: results from a randomised controlled study.

OBJECTIVES: To evaluate the utility and efficacy of colour-coded duplex scanning as an adjunct to clinical surveillance of infrainguinal vein bypass surgery. DESIGN: Prospective controlled randomised trial. METHODS: The trial included 179 consecutive patients undergoing 185 primary infrainguinal vein graft reconstructions during a 3-year period. Patients alive without amputation and with open graft at 1 month were randomised to a surveillance program based on clinical examination and ankle-brachial pressure index measurement (ABI group) or additional duplex scanning (DD group). All patients were scheduled for surveillance at 1, 3, 6, 9 and 12 months after operation. RESULTS: Surveillance identified four failing grafts in the ABI group and 11 in the DD group which were revised. The number of occluded grafts was seven in ABI group and 12 in DD group. At 1-year overall cumulative assisted primary patency rates in the ABI group and in the DD group were 74% and 65% respectively (p = 0.21), corresponding secondary patency rates were 84% and 71% (p = 0.04) and limb salvage rates 88% versus 81% (p = 0.23) respectively. CONCLUSIONS: This study failed to show any beneficial effect of duplex scanning in a surveillance program, which was difficult to accomplish as a part of routine clinical work. However, the main difference in outcome appeared during the first postoperative month before the commencement of the surveillance program.

Aged↗
PubMed1998

Influence of surgical experience on the results of carotid surgery. The Finnvasc Study Group.

OBJECTIVE: To assess the 30-day mortality and morbidity rates related to carotid endarterectomy on a nation-wide basis. DESIGN: Retrospective cross-sectional study based on vascular registry Finnvasc. MATERIALS AND METHODS: A total of 17,465 recorded vascular and endovascular procedures included exactly 1600 carotid endarterectomies performed by 104 surgeons in 23 hospitals. Fourteen per cent of the patients were operated on for asymptomatic carotid stenosis. RESULTS: The combined mortality and permanent stroke rate was 3.3%, without any difference between operations done on symptomatic or asymptomatic patients. There was a clear inverse association between surgeon's carotid case load and poor outcomes in carotid surgery (p < 0.005), the critical patient mass per surgeon and year being 10 operations. There was no association between outcome after carotid surgery and hospital volume of carotid operations. CONCLUSIONS: Surgeon's experience in carotid surgery clearly improves the results of carotid surgery.

Carotid Arteries↗
PubMed1998

Surgical treatment of chronic critical leg ischaemia. A five-year follow-up of survival, mobility, and treatment level.

OBJECTIVE: To evaluate mobility and care level required after amputation and arterial reconstruction for chronic critical leg ischaemia. DESIGN: A 5 year follow up study in three hospitals serving a defined population. SETTING: One regional and two district hospitals, Finland. PATIENTS: 117 Consecutive patients. OUTCOME MEASURES: Survival, amputations, mobility, and care level required. MAIN RESULTS: 66 Primary reconstructions, 51 primary and 35 later major amputations were done. Preoperatively 27 (53%) of the patients who underwent a primary amputation were in permanent institutional care. Of 86 patients who were living outside an institution, 62 (72%) had a reconstruction. One and five year mortality were 43% and 84% after amputation, and 20% and 57% after reconstruction, respectively. Of the patients who had had an amputation 10% were able to walk and 25% could manage to live outside an institution. Mobility and treatment level after primary and secondary amputations were similar. Forty seven (71%) of the patients who had had a reconstruction did not have an amputation. All patients whose reconstructions were successful preserved their walking ability and independent living. CONCLUSION: To maintain mobility and an independent living in patients with chronic critical leg ischaemia it is necessary to do a reconstruction that can salvage the leg. In old, institutionalised patients chronic critical leg ischaemia is often the harbinger of approaching death and then amputation is the only possible solution.

Activities of Daily Living↗
PubMed1998

Recombinant human CXC-chemokine receptor-4 in melanophores are linked to Gi protein: seven transmembrane coreceptors for human immunodeficiency virus entry into cells.

This article describes the transient expression of the CXC chemokine receptor-4 in Xenopus laevis melanophores and the resulting functional assay for the endogenous ligand for this receptor stromal cell-derived factor (SDF)-1alpha. Specifically, it will be shown that SDF-1alpha produces increased light transmittance in transfected cells that is consistent with the activation of Gi protein. This stimulus pathway is further implicated by the abolition of this response after pretreatment of the cells with pertussis toxin, a known method for the inactivation of Gi protein. The fact that SDF-1alpha does not produce responses in nontransfected cells and that treatment of the cells with 12G5, an antibody specific for the CXC chemokine receptor-4, eliminates this response indicates that this ligand produces responses by activation of this receptor in these cells. The possible relevance to human immunodeficiency virus (HIV) entry into cells was explored by observing the effects of SDF-1alpha on HIV-mediated cell fusion. It was found that SDF-1alpha blocked cell-to-cell fusion (as has been previously reported) at concentrations 1200-fold greater than those required to produce Gi protein mediated responses. The implications of the functional assay to screening for new drugs to block HIV-mediated fusion is discussed.

Amino Acid Sequence↗
PubMed1998

Treatment of depression--newer pharmacotherapies.

OBJECTIVES: Depressive disorders are persistent, recurring illnesses that impose enormous personal suffering on individuals and their families. Major depression alone is estimated as the fourth most important cause of worldwide loss in disability-adjusted life years and is likely to become the second most important within 20 years. A continued quest for more effective treatments has spawned newer antidepressants and herbal treatments, which have contributed to explosive growth in antidepressant prescribing, increasing pharmacy costs, and wider but sometimes confusing choices for clinicians and patients. This evidence report provides a comprehensive evaluation of the benefits and adverse effects of newer pharmacotherapies and herbal treatments for depressive disorders in adults and children. SEARCH STRATEGY: Pertinent literature from 1980 to January 1998 was identified from a specialized registry of controlled trials, meta-analyses, and experts. The registry contained trials addressing depression that had been identified from multiple electronic bibliographic databases, hand searches of journals, and pharmaceutical companies. The search, which yielded 1,277 records, combined terms "depression," "depressive disorder," or "dysthymic disorder" with a list of 32 specific "newer" antidepressant and herbal treatments. SELECTION CRITERIA: Randomized controlled trials were reviewed if they (1) were at least 6 weeks in duration; (2) compared a "newer" antidepressant with another antidepressant (newer or older), placebo, or psychosocial intervention; (3) involved participants with depressive disorders; and (4) had a clinical outcome. Two or more independent reviewers identified 315 trials that met these criteria. DATA COLLECTION AND ANALYSIS: Two persons independently abstracted data from each trial. Data were synthesized descriptively, paying attention to participant and diagnostic descriptors, intervention characteristics, study designs and clinical outcomes. Some data were analyzed quantitatively using an empirical Bayes random-effects estimator method. Primary outcomes were response rate, total discontinuation rates (dropouts), and discontinuation rates due to adverse events. Response rates were defined as a 50 percent or greater improvement in symptoms as assessed by a depression symptoms rating scale or a rating of much or very much improved as assessed by a global assessment method. MAIN RESULTS: There were 264 trials that evaluated antidepressants in patients (adults and children) with major depression. Of these, 81 compared newer agents with placebo, 150 newer with older agents, 32 newer agents with newer agents, and 1 newer agent with psychotherapy. There were 14 trials evaluating hypericum (St. John's wort), 27 trials each in primary care patients and older adults, 10 trials limited to patients with specific concomitant illnesses, 9 trials in patients with dysthymia, 3 trials each in patients with mixed anxiety depression and subsyndromal depression, 2 trials in adolescents, and 1 in the postpartum setting. Most trials were conducted in outpatients and examined only acute phase treatment of less than 12 weeks' duration. Newer antidepressants were more effective than placebo in treating major depression (risk ratio 1.6, 95% CI 1.5 to 1.7) and dysthymia (risk ratio 1.7, 95% CI 1.3 to 2.3). They were effective among older adults and in primary care patients. In general, there were no significant differences in efficacy among individual newer agents or between newer and older agents. Hypericum (St. John's wort) was more effective than placebo in treating mild to moderately severe depressive disorders (risk ratio 1.9, 95% CI 1.2 to 2.8). Whether hypericum (St. John's wort) is as effective as standard antidepressant agents given in adequate doses was not established. No significant differences were found between newer and older antidepressants in overall discontinuation rates. Selective serotonin reuptake inhibitors (SSRIs), reversi

Adult↗
PubMed1998

Do vascular registers affect decision-making? Finnvasc Study Group.

Treatment activity of vascular diseases varies depending on population, preference of doctors and the availability of vascular surgical services. Vascular registry offers an opportunity to review practice, to compare outcome with a standard, and to implement change to improve practice. Prospective data collection of all reconstructive vascular procedures has been performed in Finland for seven years. According to a review of the first five years, combined vascular and endovascular activity has increased nation-wide from 3508 procedures done in 1991 to 5200 in 1995. There are marked regional differences in the frequency and selection of various treatment modalities, which can not be explained only by epidemiological data but as well by skewed vascular care delivery. This data can be used for decision-making and should be used for planning of the vascular surgical services in Finland.

Data Collection↗
PubMed1998

A case for an aggressive reconstruction policy for CLI.

Chronic critical leg ischaemia (CLI) occurs with increasing frequency in the population. A main reason for this is the increasing proportion of elderly persons in the population. CLI mostly affects persons over the age of 65 and a substantial proportion of the patients are more than 80 years old. Most patients have multiple risk factors, the most frequent being diabetes and various manifestations of cardiovascular disease. The main arterial changes are found in infrainguinal arteries in three-quarters of the patients and in 25-50% of the patients CLI will also affect the other leg at some time. Long infrainguinal bypasses are necessary for a successful treatment in most cases. Despite problems, reconstructive arterial surgery can be performed with acceptable morbidity and mortality. Re-interventions are necessary for many patients and regular follow-up should be a part of the treatment. The clinical results can ensure that most patients will have a reasonable quality of life. For society, reconstructive surgery is cost-effective as it reduces costs for long term care that otherwise would have been necessary after amputations.

Aged↗
PubMed1997

Femorotibial reconstructions for chronic critical leg ischaemia: influence on outcome by diabetes, gender and age.

OBJECTIVES: To analyse the influence of risk factors on the outcome of femorotibial reconstructions for chronic critical leg ischaemia. DESIGN: A longitudinal observational study of patients undergoing femorotibial reconstruction. SETTING: A regional hospital and an academic referral centre. MATERIALS: One hundred and eighty-eight patients undergoing 209 reconstructions to the tibial vessels for chronic critical leg ischaemia, 149 of them with in situ vein grafts. CHIEF OUTCOME MEASURES: Graft patency, leg salvage and survival rates. MAIN RESULTS: Severity of preoperative ischaemia influenced the immediate outcome of reconstruction. Increasing age did not influence graft patency, leg salvage or survival rates. A combination of female sex and diabetes was associated with low graft patency and leg salvage (52% and 42% at 18 months). Diabetes was associated with a decreased survival. CONCLUSIONS: With proper patient selection, patency and leg salvage rates in older (> 80 years) patient groups with multiple risk factors justify an active reconstruction policy.

Age Factors↗
PubMed1997

Auditing a nationwide vascular registry--the 4-year Finnvasc experience. Finnvasc Study Group.

OBJECTIVE: To assess the validity of a national vascular registry. MATERIALS AND METHODS: 17,465 vascular and endovascular procedures, immediate reoperations excluded, registered in the Finnvasc registry from 26 centres during the years 1991-1994. CHIEF OUTCOME MEASURES: Comparison of the number of registered procedures with hospital records, comparison of initial registrations with a random sample of re-registration and comparison of the 1-year local data input of one major centre to the same data input of the central unit. RESULTS: The rate of missing registrations was 19% ranging from 0-47%. The data of the re-registered forms were in agreement with the original data in 93% of all data points, the range being from 81-100%. There was a difference of 1.5% in the data between the major centre and the central unit. CONCLUSIONS: The Finnvasc registry makes it possible to audit vascular surgery nationally, although a potential limitation is centres with low registration rates.

Finland↗
PubMed1997

Surgical treatment for chronic critical leg ischaemia: a 5 year follow-up of socioeconomic outcome.

OBJECTIVES: To evaluate the costs of amputation and arterial reconstruction for chronic critical leg ischaemia (CLI). DESIGN: A 5 year follow-up study of patients with primary intervention for CLI. SETTING: One regional and two district hospitals serving a defined population. MATERIAL: One hundred and seventeen consecutive patients undergoing reconstructive arterial surgery or amputation for CLI. CHIEF OUTCOME MEASURES: Additional procedures, treatment resources and costs related to the treatment of CLI. MAIN RESULTS: Reconstruction patients needed frequent reinterventions due to graft problems, additional CLI symptoms and revisions of ischaemic tissue. The mean costs for a reconstruction were 240,000 FIM/patient and 70,000 FIM/survival year including costs for later amputations. Patients with a reconstruction without later amputation had costs of 175,000/ patient and 47,000/survival year. A reconstruction with a later amputation had the highest costs, 402,000/patient and 148,000/survival year. Contralateral leg ischaemia caused a new intervention in 25% of all patients. For non-institutionalised patients an amputation resulted in institutional treatment in over 20% of the remaining surviving days with a cost of 313,000 FIM/patient and 150,000 FIM/survival year. CLI in institutionalised patients with a primary amputation had a short stay in hospital, needed little additional resources and caused only low additional costs. CONCLUSIONS: Costs for a reconstruction in potentially mobile, independently living patients with CLI is similar to those of an amputation. It often demands repeated interventions to achieve good results. On a cost/survival year basis, amputations carry higher costs. For institutionalised, immobile patients with CLI an amputation is often the only possible and cheapest treatment.

Aged↗
PubMed1997

Mortality in abdominal aortic aneurysm surgery--the effect of hospital volume, patient mix and surgeon's case load.

OBJECTIVE: Assessment of mortality in abdominal aortic aneurysm surgery. DESIGN: A 4-year cross sectional study based on a nationwide vascular registry: Finnvasc. MATERIAL AND METHODS: A total of 17,465 vascular interventions included 929 elective repairs for abdominal aortic aneurysms (AAA), and 610 emergency cases with 454 ruptures. Fifty-three percent of the operations were done in university hospitals, 44% in central hospitals and 3% in district hospitals. RESULTS: The 30-day mortality rate for AAA repair was 5.1% in elective and 46% in ruptured cases. A clear dependence of operative mortality on surgeon's experience in AAA surgery was observed, both regarding the surgeon's total vascular case load (p < 0.01) and the number of operated elective aneurysms (p < 0.01), but not the number of operated ruptured aneurysms. However, no association was found between hospital volume and mortality in AAA surgery. CONCLUSIONS: Vascular surgical experience clearly improves the results of elective aneurysm surgery.

Aneurysm, Ruptured↗
PubMed1997

Treatment of murine Candida krusei or Candida glabrata infection with L-743,872.

L-743,872 is a broad-spectrum pneumocandin antifungal drug developed by Merck Research Co., and in the present work it was evaluated in vivo in murine models of Candida krusei and Candida glabrata infection. Mice were infected intravenously with two isolates of C. krusei and treated with fluconazole or L-743,872. Fluconazole was beneficial only in immune-competent mice infected with isolate 94-2696. At > 0.5 mg/kg of body weight/day, L-743,872 was effective against both infecting isolates in immune-competent and immune-suppressed mice. Against C. glabrata, L-743,872 was effective, at doses > or = 0.5 mg/kg, in reducing fungal cell counts in the kidneys but not in the spleen. L-743,872 has significant potential for clinical development.

Animals↗